mechthild meyer (gentium consulting) alma estable (gentium consulting)
Post on 27-Jan-2016
27 Views
Preview:
DESCRIPTION
TRANSCRIPT
Critical Assessment of Type 2 Diabetes Prevention Interventions in Canada:
Finding a path through the evidence labyrinth
1
Mechthild Meyer (Gentium Consulting)
Alma Estable (Gentium Consulting)
Laurie Gibbons (The Public Health Agency of Canada)
www.gentium.ca
What we hope you will take away
What works: Know evidence-based components for lifestyle interventions to prevent type 2 diabetes
An approach: A way to map out the components of these interventions
2
Imagine this…Your role: Program planner (chronic disease
prevention) at a health department (HD)
Context: HD in a mid-size town, main employer: paper mill
Public Health Standard Requirement: Develop programs that are ‘evidence-based'
Chronic Disease Prevention: Reduce obesity, pre-diabetes
HD strategic goal: Decrease percentage of the adult population with pre-diabetes (obese, overweight) by 2% over the next ten years
HD target: Hard to reach adult population, especially males3
Where to start …. assessing the effectiveness of interventionsLifestyle and environmental
interventions resulting in lasting behavioural change
You heard that most focus on reducing weight or preventing weight gain through
Physical activityDietary behaviour
Hunch/Myth or evidence?
4
Looks familiar?
Assessing the effectiveness of type 2 diabetes interventions
Systematic Reviews, Syntheses
6
Multiple combinations
of intervention components
What part of the
intervention makes it effective?
What does the evidence say?Evidence contradictory and limited: Lifestyle interventions are as effective as
pharmaceutical interventions to reduce the rate of progression to type 2 diabetes
Effective components:
• Intensive low-fat diets + exercise + counselling
• “Mediterranean” diet combined with behaviour therapy
Types of effective lifestyle interventions are:
• Sustained, long-term, intensive, multicomponent
7
What does the evidence say?Diet-only interventions
Exercise-only interventions
8
• Some reduce weight
• Long-term follow-up: no evidence in diabetes risk reduction
Increase physical activity, e.g., walking
Limited evidence: changes last
Insufficient evidence: reduce risk factors for diabetes
Combined interventions• Evidence: Diet + Exercise + psych. support
reduce incidence of type 2 diabetes in high risk groups (pre-diabetes or metabolic syndrome)
Intervention Components
9
Multiple Intervention Components
Education
Counselling
Diet Modification
Physical Activity Modification
DevicesEnvironment, policy change
What is an Intervention?
10
What: components (i.e., diet, PA)
Interventions are complex with many different components
Approach: activities (i.e., course, counselling) How: delivery (i.e., online, in person)
Who: intermediaries (e.g., teacher, dietician)
Where: setting (e.g., school, workplace)Timing: length (e.g., 3-months, follow-up)
Interventions may include a variety of components
What (content)
Nutrition: reduced overall calories
Nutrition: reduced fats
Nutrition: increase in
fibre
Nutrition: increase in F&V intake
Physical Activity: reduced
screen time
PA: increased level of PA
PA: increased walking
Approach (activity)
Advice, prescription
Counselling ortherapy
Support (peer, family, work crew)
Program sessions, course,
curricula, structured
Environmental changes,
policies
Incentives (monetary, time, value
driven)
Media campaign,
communication
How (medium)
Devices (pedometers, prepared
foods)
Individual (one-on-one)
In groups, supervised
Print material, info. in writing
Telephone
Internet, web-based, email, SM,
apps
In groups, unsupervise
d
Who (intermediari
es)
Professional (i.e. health,
teacher, trainer)
Para-professional,
peer
Family, parent, friend
Researcher
Self-managed
Policy makers
Where (site)
Home
Community, neighbourho
od
Population-wide
School, daycare
Clinical setting, hospital
Workplace
Research institute
Timing (length,
frequency)
Once
Regularly, over a
specific time frame
Ongoing, sustained
With follow-up
No follow-up
One to 12 years
Unspecified
11
Example: POWER - Preventing Obesity Without Eating like a Rabbit (Australia)
What: change in nutrition, physical activityWhere: Workplace, target: overweight, obese,
male, blue collar shift workersApproach: One educational information session
(behaviour change strategie, monetary incentives)
How: Weight loss handbook, pedometerWebsite: online support
Self-weighing each week
Email feedback by professionals
Who: Delivered by trained staffTiming: 14 weeks with follow-up
12
POWER - Evidence (outcomes)
13
After 14 weeks participants had lost significantly more weight (on average 4.3 kg), about 5% of their baseline weight, than controls
Significant effects on waist circumference, BMI, systolic blood pressure, resting heart rate and physical activity.
Only 28% of men in the intervention group used the online component of the intervention, but those who did lost most weight
Source: Morgan et al. (2011). Efficacy of a workplace-based weight loss program for overweight male shift workers: the Workplace POWER (Preventing Obesity Without Eating like a Rabbit) randomized controlled trial. Prev Med, 52(5), 317-325.
Example: POWERWhat
(content)
Nutrition: reduced overall calories
Nutrition: reduced fats
Nutrition: increase in
fibre
Nutrition: increase in F&V intake
Physical Activity: reduced
screen time
PA: increased level of PA
PA: increased walking
Approach (activity)
Advice, prescription
Counselling or Therapy
Support (peer, family, work crew)
Program sessions, course,
curricula, structured
Environmental changes,
policies
Incentives (monetary, time, value
driven)
Media campaign,
communication
How (medium)
Devices (pedometers, prepared
foods)
Individual (one-on-one)
In groups, supervised
Print material,
info.in writing
Telephone
Internet, web-based, email, SM,
apps
In groups, unsupervise
d
Who (intermediari
es)
Professional (i.e. health,
teacher, trainer)
Para-professional,
peer
Family, parent, friend
Researcher
Policy makers
Self-managed
Where (setting)
Home
Community, neighbourho
od
Population-wide
School, daycare
Clinical setting, hospital
Workplace
Research institute
Timing (length,
frequency)
Once
Regularly, over a
specific time frame
Ongoing, sustained
With follow-up
No follow-up
One to 12 years
Unspecified
14
Example: POWER
What
(content)Nutritio
n: reduced overall caloriesNutritio
n: increas
e in F&V
intakePA: increased level
of PAPA:
increased
walking
Approach
(activity)
Support (peer, work crew)
Program
session
Incentives
(monetary)
How (medium
)
Devices (pedomet
er)
Print material
Web-based, email
In groups,
unsupervised
Who (intermedia
ries)
Professional
Self-managed
Where (setting)
Workplace
Timing (length,
frequency)
Regularly, 14-weeks
With follow-
up
15
Conclusions
Mapping out intervention components may make it easier to know what combination lead to the ‘evidence’ (desired outcomes)
Knowing the components facilitates program planning
Program planners can be more confident that their program is evidence-based
16
Thanks!For more information:
Mechthild Meyer: meyer@gentium.caAlma Estable: estable@gentium.caLaurie Gibbons: laurie.gibbons@phac-aspc.gc.ca
Gentium Consulting: www.gentium.ca The Public Health Agency of Canada
17
top related